CDC’s Diabetes Prevention Program – Questions and Answers #2

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Q. Is it possible for someone in private practice to offer the MDPP as a solo practitioner?

A. Solo practitioners would need to start a National DPP and obtain full CDC Recognition to apply to enroll as a Medicare Supplier for the MDPP. Individuals in private practice can also partner with existing or new programs to provide the lifestyle coaching or serve as a program coordinator as independent contractors. The program would need to obtain the solo practitioner’s NPI for the coach roster. Medicare pays the recognized Medicare Supplier, and the program would pay the practitioner providing services for lifestyle coaching.

Q. If someone is <65 and has prediabetes but is not overweight, is he/she eligible for the program (i.e., the MDPP benefit)?

A. No. Medicare beneficiaries with a body mass index (BMI) of < 25 are not eligible to participate in the Medicare DPP benefit. The Medicare criteria for the Part B benefit is a BMI of ≥ 25 and abnormal blood glucose results. The Medicare DPP is an important new benefit to help Medicare beneficiaries prevent and/or delay diagnoses of diabetes, yet it does not meet the needs of all populations with prediabetes.

A note about individuals with Medicare Advantage plans or other individuals < 65 with private insurance: It is possible that individuals with private insurance, including Medicare Advantage plans, who have prediabetes and BMI < 25, have a benefit for MNT that may cover a diagnosis of prediabetes. Individual plan benefits and coverage policies determine what services are covered benefits and terms/conditions for coverage. We encourage RDNs and organizations to confirm benefits for MNT in persons with prediabetes.

Q. How do you become a Master Trainer?

A. As of the date of the webinar, there are three organizations (Diabetes Training and Technical Assistance Center at Emory University, American Association of Diabetes Educators, and the Diabetes Prevention Support Center of the University of Pittsburgh) that currently provide Master Training. The minimum required qualifications for application to a Master Trainer Program are:

Previous completion of Lifestyle Coach Training from a CDC-recognized national provider

Affiliation with an organization that has pending or full CDC recognition

Successful delivery and experience with the National Diabetes Prevention Program

Some of the organizations also require the applicant to be a health care professional with a minimum of a bachelor’s degree in a health-related field or if not, substantive experience. There is an application form to be completed, letters of recommendation from a supervisor or a professional who can provide information about your experience and performance in delivery of a lifestyle change program, and often a phone interview. Successful applicants attend a 2-day training, similar to the Lifestyle Coach Training Program, to become qualified to become a Master Trainer. The fees range from $1500-$1650 which includes the training and the membership/agreement fee for post-training technical assistance and licensing of the training materials. Master Trainers can train lifestyle coaches in their own and partner organizations.

Q. Can RDNs in private practice order blood tests for diabetes screening?

A. The Academy recommends that RDNs refer to the Comprehensive Scope of Practice Resource for the RDN which can guide the RDN to the resources and options that can be used to evaluate whether the RDN can safely and effectively provide an expanded practice skill and advance individual practice. Case Study: Initiating Orders for Nutrition-Related Laboratory Tests for RDNs Practicing in Hospital, Ambulatory and Private Practice Settings Academy Store: http://www.eatrightstore.org/product/AE37FD36-0C17-422C-91F6-E3C9DC845986

A. Beneficiaries will have access to ongoing maintenance sessions after the MDPP core benefit (1st 12 months of the program). At the time of the webinar CMS had not placed any limits on how long CMS will pay for ongoing maintenance sessions. Eligible beneficiaries will have access to ongoing maintenance sessions after the MDPP core benefit if they achieve and maintain the required minimum weight loss of 5%. CMS is defining maintenance of weight loss, which allows a beneficiary to access ongoing maintenance sessions, as achieving the required minimum weight loss from baseline weight at any point during the previous 3 months of the core maintenance or the ongoing maintenance sessions. CMS will propose a limit on the duration of CMS payments for ongoing maintenance sessions in future rulemaking. As a reminder, there are six monthly core maintenance sessions in months 6 through 12 of the year-long program in which beneficiaries are eligible to participate, regardless of weight loss, but CMS has not issued final rules about payment for the core maintenance component or any component of the MDPP benefit.

About the Author: Joyce Green Pastors, MS, RD, CDE, VAND Member and one of the Virginia Diabetes Council Board Members, participated in a webinar on May 24th, 2017 for the Academy of Nutrition and Dietetics about diabetes prevention. We thank them for sharing information from this webinar with us.

Do you have questions regarding the National Diabetes Prevention Program? Over the next few weeks we will feature posts that address questions about the program.

First let’s begin by defining the terms.

Diabetes Prevention Program (DPP) was the research trial led by the National Institutes of Health with financial and scientific expertise from Centers for Disease Control and Prevention (CDC), and others.

National Diabetes Prevention Program (National DPP) is the overarching program/framework for implementation of the lifestyle change intervention for those with prediabetes/high risk for type 2 diabetes.

The Medicare Diabetes Prevention Program (MDPP) refers to the new Medicare Part B benefit for the National DPP lifestyle change intervention for eligible Medicare beneficiaries.

Q. What is the difference between the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program?

A. The National Diabetes Prevention Program (National DPP) is the overarching program/framework for implementation of the lifestyle change intervention for those with prediabetes/high risk for type 2 diabetes. The Medicare Diabetes Prevention Program (MDPP) refers to the new Medicare Part B benefit offering coverage for the National DPP lifestyle change intervention for eligible Medicare beneficiaries. Programs must have recognition by the Center for Disease Control and Prevention (CDC) to deliver the MDPP benefit.

Q. Is it mandatory for lifestyle groups to be certified for program accreditation and Medicare reimbursement?

A. Medicare will require NDPP programs to have full CDC recognition (administered by the CDC Diabetes Prevention Recognition Program, part of the National DPP) to be eligible to enroll in Medicare as Medicare Suppliers. CMS may consider another category of recognition that would be addressed in future rulemaking.

Q. Can an RDN apply for a National Provider Identifier (NPI) number even if not planning to use it quite yet? Does it require renewal?

A. A registered dietitian nutritionist (RDN) can apply for an NPI at any point in time, whether for current or future use. The Academy recommends that every RDN have an NPI regardless of employment status or place of work, or whether the NPI is being used by the RDN or an organization for billing purposes. NPIs are one way to demonstrate RDN workforce availability to payers including Medicare, private payers, and state Medicaid agencies. An NPI does not require renewal and it never expires. Nutrition and dietetics technicians, registered (NDTRs) and other nutrition and dietetics practitioners can also obtain NPIs at any time. There is a specific NPI taxonomy category for “dietetic technician, registered.” Nutrition and dietetics practitioners who are not RDNs or NDTRs can select “Health Educator” for the taxonomy.

Q. I’m unclear as to whether each health coach needs an individual NPI or if the program can use the hospital NPI?

A. Each Lifestyle coach who delivers the NDPP to Medicare beneficiaries under the new Medicare benefit (MDPP) will need an individual NPI. Programs that apply to enroll as Medicare Suppliers of the MDPP are required to submit and maintain a coach roster with NPI numbers for all coaches. Individual coach NPIs will not be used forbilling purposes in the MDPP. The Medicare Supplier (must be a program) will use the program NPI to submit claims to CMS.

Q. When do you apply for the MDPP NPI number?

A. Organizations who want to deliver the MDPP benefit will need to provide a list of coaches and their NPIs when they apply to enroll as a Medicare Supplier. Organizations can apply for Medicare Supplier enrollment if the NDPP program has already obtained full CDC Recognition. https://nccd.cdc.gov/ddt_dprp/registry.aspx.

About the Author: Joyce Green Pastors, MS, RD, CDE, VAND Member and one of the Virginia Diabetes Council Board Members, participated in a webinar on May 24th, 2017 for the Academy of Nutrition and Dietetics about diabetes prevention. We thank them for sharing information from this webinar with us.

On Monday, February 27, 20107 the Obesity Care Advocacy Network (OCAN) and dietitians from across the United States met in Washington, D.C. to meet with members of Congress to advocate for the Treat and Reduce Obesity Act (TROA) of 2017 and the establishment of a National Obesity Care Week (NOCW). Obesity Advocacy Day attendees were divided into groups and traveled to various legislative offices to meet with Congress men and women to discuss and advocate for the TROA. The TROA consists of two parts which aim to:

Currently, CMS coverage for IBT is limited to being provided by a primary care provider in the primary care setting. Because of this narrow coverage, nutrition professionals, endocrinologists, bariatric physicians, psychiatrists, clinical psychologists, and other specialists are unable to be reimbursed for providing these services. When Congress enacted Medicare Part D, (the Medicare prescription drug program), obesity was not recognized as a disease, but rather a lifestyle condition. Additionally, there were no widely-accepted FDA-approved weight loss medications on the market. It was for these reasons that pharmaceutical weight loss aids were not covered under Medicare Part D. Due to Medicare’s current limitation on providers of IBT and Medicare Part D’s lack of coverage on pharmaceutical weight loss aids, the TROA aims to change these aspects of Medicare coverage. Lastly, the establishment of a NOCW aims to elevate societal awareness of obesity and weight bias as well as facilitate a shift to science-based treatment for those living with obesity. The act proclaims the week of October 29-November 4 as National Obesity Care Week.

About the author: Katie Couch

Katie is currently a dietetic intern at the University of Virginia Health System. She completed her undergraduate degree in Nutrition Science and Master’s degree in Nutrition Science from Auburn University. She enjoys cooking, reading, and exploring her new city of Charlottesville!

Over the past six weeks, VAND’s Executive Director Search Committee comprising Carlene Thomas (Chair) Lesley McPhatter, Kimberly Lunsford and me, has been recruiting for a new Executive Director. We are pleased to let you know that Jillian Davis, RDN, has accepted the position!

Jillian is very excited to serve the VAND community of nutrition professionals as the new Executive Director! She has enjoyed past experiences in many different areas of nutrition including the clinical setting, food marketing and promotion, and community education. She has worked as a School Marketing Manager with the Mid-Atlantic Dairy Association, supporting nutrition education programs throughout northern Virginia, and most recently served as Family and Consumer Sciences Extension Agent in Charlottesville and surrounding counties, as well as in Fairfax County. Her experience with individuals, families, and nutrition professionals throughout the state has provided her with a unique view of the diverse communities we serve in Virginia. In addition to her work as a Registered Dietitian Nutritionist, Jillian enjoys walking, jogging, knitting, reading, gardening, and experiencing the fullness of life with her family.

She will begin learning the ropes over the next few weeks by working with Jackie Darling, Interim Executive Director; Shirley Scrafford, Cvent Coordinator; Kristen Chang, Website Coordinator; Cindy MacIntyre, Treasurer, and the rest of the Executive Board.

Please plan on attending the Annual Meeting so you can meet Jillian in person!

Almost 100 RDNs, DTRs, interns and students spent a rewarding day in Richmond visiting our legislators. We split into two groups so when we were introduced (the famous “shout out) to the Assembly and the Senate, 50 of us stood in unison in each gallery to represent Virginia’s nutrition experts who promote the health of Virginians! This record-level attendance required leadership and coordination and for that we thank Angie Hasemann, State Policy Rep; Faye Krause and Alex Wahlberg Assistant SPRs, Christine Gries, State Regulatory Specialist, our five District Legislative Representatives, Blue Ridge (Sara Mastrantonio), Northern (Jackie Darling), Richmond (Nana Ofosu-Benefu), Southwest (Susan Noble) and Tidewater (Amber Rivera) Andrew Lamar, Legislative Consultant, and Amy Scott-MacLean. Attendees were surprised to actually meet with legislators who had time to talk about legislation VAND was supporting.

Read more about Legislative Day in the NEWSLETTER posted on the website and check back for even more information that will provide a more in depth discussion about VAND’s MOST SUCCESSFUL LEGISLATIVE DAY to date and lots of photos! Please plan on attending next year’s Legislative Day!

Blogging… Another Way to Make an Impact!

By now you all know that we have launched a very successful blog on our website! What you might not know is why we started this blog and why we want YOU to contribute to it. Blogging increases our online presence and helps us establish authority as the nutrition experts in the Commonwealth, provide educational opportunities for other RDNs, healthcare professionals, and the public, and promote the professional brand of VAND. It helps public policy and advocacy professionals, like our state legislators and their aides, learn who we are and what we do. Publishing on our blog can also help YOU build your professional brand and online presence. With National Nutrition Month this month, we would love to flood the blog with pictures of NNM activities throughout Virginia, and educational posts and healthy recipes to help Virginians “Savor the Flavor of Eating Right”! Submit your materials to our Professional Education Chairpersons at vand.professionaleducation@gmail.com – we can even help edit your post if you would like us to!

Have you seen the speaker line up? Have you seen the workshop topics? This is a meeting not to be missed! Margo Wootan, D. Sc. Center for Science in the Public Interest (restaurant nutrition labeling); Patsy Catsos, MS, RDN (FODMAPS), Scott Kahan, MD, MPH (What RDNs need to know about medications for weight reduction), Alanna Moshfegh, MS, RD (Chew on This Changes in Americans’ Eating Habits) to name a few!

ALL WORKSHOPS & EDUCATIONAL SESSIONS ARE STILL AVAILABLE, BUT ACCOMMODATIONS IN THE ROOM BLOCK ARE GOING FAST!

Up to 23 CPEUs are being offered over three days. VAND’s 87th Annual Meeting will host many nationally renowned speakers and local experts presenting hot topics in food and nutrition to advance practice in all areas. Log onto VAND’s website at www.eatrightvirginia.org and click on the Annual Meeting announcement to check out the meeting site. Here you can view the program agenda, meet the speakers, access hotel information and register online with a credit card.

Early bird registration fees are available NOW through March 18th

Fairfax Marriott at Fair Oaks,

11787 Lee Jackson Memorial Highway,

Fairfax, VA 22033

Academy Elections

The final numbers are in and 14.48% of VAND’s membership voted in the Academy elections coming in 3rd place in Category 3 behind Georgia’s 26.15% (Donna Martin from GA was selected as AND’s President-Elect so they had lots of GOTV energy) and Alabama’s 16.09%. In 2015, VAND had 9.1% of its members vote so a 37% increase in participation is great improvement.

Upcoming Events

March VAND Elections—will be announcedMarch Webinar—will be announced soon, stay tuned!

March 2016 National Nutrition Month: “Savor the Flavor of Eating Right” www.eatrightpro.org has lots of resources for RDNs and NDTRs to use.

April 10-12: Annual Meeting:, Fair Oaks Marriott, Fairfax, VA

April 10: Board Meeting 5:30 pm

July 8-9: Board Retreat – Roslyn Center – Richmond, VA

As always, I am interested in your insights, your questions, and requests.